RT @neiljlangridge: The “so what, why and how” simple reasoning to help students -

Developing students’ thinking around #MSK #rehab planning: the “So what, why and how” approach Our latest #ClinicalInsight provides a short reflection from a team member who has been asked to help first year #physiotherapy students in how they can create management plans through the patient story and examination. We include: ➡️ Establishing ‘so what’ ➡️ Linking the why ➡️ How to know if relevant? ➡️ Key features of the “So what, why and how” approach You can read the full article here: We hope this will be of interest @MattLowPT @PhysioMACP @neiljlangridge

RT @APPN_physio: A fantastic presentation by @neiljlangridge @appn study day - contemporary clinical reasoning - what’s next? 👇👇👇👏👏#Advance…

RT @WoodwicksLianne: Great to hear @neiljlangridge talking on complex clinical reasoning and diagnostic uncertainty in clinical practice at…

Reflecting on the Clinical Decision: Putting the Pieces Together Our previous two #ClinicalInsights explored: ➡️The relationship of the clinician’s emotions and their effects on decision-making in the clinic ➡️How we take social and clinical cues from patients to build an understanding ➡️Some of the subtle clinical reasoning faults that may occur as we move through this. This week's #ClinicalInsight looks at how we manage this challenge, offering some tips on how to build around this problem. Leadership theory and models of learning start very much with how we understand ourselves, then how this can impact others. We then use that knowledge effectively to be able to adjust our leadership behaviours to ensure we present as authentic, compassionate and trustworthy. Presenting as an Authentic Clinician This is how a clinician can begin to gain insight and unpick complexity. If we present as the authentic clinician, then the patient is far more likely to disclose, and this deals with one of the pillars of uncertainty, which is not knowing what the patient expects, wants, or is concerned about. If we are uncertain about that, how do we ever develop an effective management plan? Use a Framework Secondly, when dealing with uncertainty we need to be able to place abstract ideas, presentations into a framework, and this requires some sort of testing protocol. In doing so we can improve how we make sense of symptomology and patient experiences. This is challenging, and allows for the therapeutic alliance to be structured. It’s a deep example of creating a research-like question and subsequent protocol within the clinical interaction. Building a Patient Story Lastly, we need to deal with technical uncertainty as we try to apply “test” to the presentation, such as clinical bedside and of course more structured rather like imaging. So, the building of the patient story has to be constructed, when it’s complex, around multiple mini frameworks that then allow the emotional and less structured (but vital) elements to be understood not only from the patient’s perspective, but by the clinician within a more objective framework. Experts live with uncertainty, however they mitigate for this by having a greater appreciation of their impact on the consultation, by creating developed models of how to deal with less obvious cues that underpin a patient story, and lastly modifying the consultation to try to create a better objective model for dealing with uncertainty. You can read the full article and previous Clinical Insight articles on our website here: References Ghosh, A.K., 2004. On the challenges of using evidence-based information: the role of clinical uncertainty. Journal of Laboratory and Clinical Medicine, 144(2), pp.60-64. Stern, D., Smith, K. and Rone-Adams, S., 2020. Using A Self-Contained Integrated Clinical Education (ICE) Model to Identify Student Deficits.

RT @neiljlangridge: Really pleased to welcome our Consultant Orthopaedic surgeon to our University clinic team today - Mr Muthian will be d…

🚀 Introducing Our New On-Site Orthopaedic Outpatient Clinic 🚀 We’re thrilled to announce the launch of an on-campus orthopaedic outpatient clinic, led by Consultant Orthopaedic Surgeon Mr. Senthil Muthian. This clinic offers individuals an opportunity to explore their musculoskeletal options—whether surgical, interventional, or rehabilitative. Dr. Neil Langridge, Director of Clinical and Rehabilitation Services, highlights the advantages of the clinic, saying: “This service gives patients fast access to a surgical opinion and personalised treatment options, all in one location.” 🔹 Why Choose Our Clinic? • Expert opinion: Mr Muthian is a highly regarded Consultant Orthopaedic Surgeon, with a specialism in upper limb conditions and trauma. He can offer opinions on all types of orthopaedic interventions. • Streamlined Care: From initial assessment and imaging to advanced injections and rehabilitation, our clinic offers comprehensive support—all conveniently on one site. • Fast Access to surgical care: Skip the usual steps and get direct access to surgical opinions, imaging, and intervention options. This clinic is all about offering patients clarity, options, and control over their health journey. 💪 Learn more about how our Orthopaedic Outpatient Clinic can support you #orthopedics #orthopedicsurgery #orthopaedic #Orthopaedics #orthopaedicconsultant #MusculoskeletalHealth #MSKHealth

This week's #ClinicalInsight is Part Two in our current series exploring clinical decision-making. This article reflects on subconscious cues in making a clinical decision. As clinicians know, clinical reasoning involves the cognitive processes that culminate in a diagnosis and treatment plan. The process itself is difficult to analyse and especially in experts where non-analytic reasoning, which is believed to be mainly subconscious, features as the premise for fast thinking or pattern recognition. Cognitive expertise involves the linking of information via a set of perceptual cues into a more meaningful pattern. The dual process theory that allows humans to be able to move from fast patterns to slow analytical models is reflected in clinical practice. Errors in Reasoning Errors in reasoning are clearly commonly experienced and can range across cognitive bias and knowledge gaps. Clinicians can too early anchor a diagnosis, look to confirm it with a less analytical assessment of relevant information, or perhaps premature closure without considering other sources. The subtly of practice and information can be built on subconscious cues that essentially raise an awareness and a more analytical approach of enquiry. These can be linked to previous experiences, knowledge, or a blend of past encounters that build a picture for the clinician. Responses can be augmented as physical experiences in the clinician, such as heart rate, sweating or breathing, rather like a mild stress response, if there is concern. Otherwise, it’s a level of conscious confidence that builds as the pattern “fits”. Clinical Clues The subtle clinical cues are different for every patient: they can be physical, emotional, verbal, or non-verbal. These can be a way something is explained, the words, phrases, description. It could the way a patient shows where the symptoms are and the words used in conjunction with this to describe it. The responses to the specific questions, some of course may be evidence based to inform, others just from prior experience. The clinician may enquire in a certain way to see if a familiar response is gained. The way the patient interacts non-verbally will be full of clues to be explored, and in the end analytically accepted or rejected based on clinical relevancy to what might be happening. Essentially, sub-conscious cues become conscious through analysis, concern, or linking patterns. Clinicians, although looking for “tests” that offer sensitivity / specificity, have to be aware of the subconscious to conscious cueing of meaning, and the wax and wane of fast to slow reasoning through the clinical encounter. By doing so, improved diagnosis and reflection is more likely to be achieved as experience is gained. This Clinical Insight article is Part Two in our current series – Part One explored the “Yellow Flags” of the Clinician: Reasoning, Reflection and Responses. You can read the full article here: References Corrao, S. and Argano, C., 2022. Rethinking clinical decision-making to improve clinical reasoning. Frontiers in Medicine, 9, p.900543. van den Berg, B., de Bruin, A.B., Marsman, J.B.C., Lorist, M.M., Schmidt, H.G., Aleman, A. and Snoek, J.W., 2020. Thinking fast or slow? Functional magnetic resonance imaging reveals stronger connectivity when experienced neurologists diagnose ambiguous cases. Brain Communications, 2(1), p.fcaa023.

Are you working in Health and Social Care or do you work with people living with frailty? The Bournemouth East Collaborative PCN is hosting a "Managing Frailty within Primary Care" conference on Nov 8 at AFC Bournemouth's Vitality Stadium. The event covers topics like frailty management, dementia, heart failure, polypharmacy, and falls prevention. Details and registration: #PrimaryCare #HealthcareEducation

@cathythomsonPT Thanks Cathy, we'll take a look!

🚨 Upcoming CPD - exclusive for our partners Join us on 12 November 2024 for an insightful session on Conservative Management & Non-Operative Interventions in Lower Limb Rehabilitation This event is exclusively for members of our Clinical Partnership Scheme (if you're not yet a partner, it’s free to join! 🙌) 🎯 Why Attend? Learn practical, non-surgical treatment techniques Hear from expert speakers including Dr. Neil Langridge, Dr. Laith Al-Obaidi, Matt Pearson, and Rebekah Selby Davis 📅 Date: 12 November 2024 🕔 Time: 6:30 PM – 8:30 PM 💻 Location: Online via MS Teams 👉 Not a partner yet? Sign up for free and gain access to this exclusive CPD event and future opportunities #ClinicalPartnership #CPDEvent #Physiotherapy #Orthotics #MSK #LowerLimbRehab #HealthcareInnovation #UltrasoundInjections

We hope our latest Clinical Insight article is of interest to you: @ProfLesleyHaig, @MattLowPT, @timnoblet, @PhysioMACP. Focusing on the 'yellow flags' of the clinician - and part one of a three-part series on this topic.

The “Yellow Flags” of the Clinician: Reasoning, Reflection and Responses In this week’s #ClinicalInsight, we shine a light on how we as clinicians can construct the psychological & emotional barriers that may negatively affect #patients in their #recovery. We perhaps fail to consider these as “thought faults” within our own clinical reasoning. Stress Let’s firstly consider #stress. Stress in some cases can cause alertness, vigilance and pace of thinking but overtly may lead to a lack of logicality, rationalisation and clarity. Therefore, as clinicians how do we understand the decisions we might make under higher levels of stress in terms of criticality and confidence? Reflection will be essential here, but within that reflective model we may in practice need to ascertain our own emotional barriers that could be at play before reflecting on our objectivity in the patient assessment. Anxieties Around Practice Secondly, anxieties around practice, making the right decision, not missing things and ensuring we have covered all bases could lead to a practice anxiety, which in the same way as patients, can lead to over-vigilance and restrictions to freedom to think, which can limit the management of complexity rather than enhance it. Cognition is not separate from emotion, and the two intertwine via the adaptable clinician. Cognition is tiring as we deal with the amount of information offered to us as clinicians, and those with less experience may have to focus in a different way. Therefore, even the time of day, the type of day and overall, how we are feeling, will potentially affect our reasoning skills. Social Factors Our social factors can also affect our reasoning. Many name this a bias, but essentially our social perspectives, values and experiences will affect how we interact, gain knowledge from the patient narrative, and of course influence our interpretation. Our own physical stresses that we deem as emotional will of course impact reasoning physically. Heightened awareness manifesting as heart rate change, increasing sweat and breathing rates will all lead to that “feeling” of anxiety, and of course this can become associated with a certain presentation or condition. This might happen if a clinician had a negative experience with a similar presentation in the past, and this can then “tag” itself and lead to a raised consciousness in the clinician, which may enhance or negatively affect the outcome. It is vital as reasoning, reflecting clinicians that we consider our own “clinician yellow flags” before we even think about the equivalence within the patient story. In Part Two of this three-part series, we'll be exploring subconscious cues in Clinical Reasoning. References Bar, M., 2009. The proactive brain: memory for predictions. Philosophical Transactions of the Royal Society B: Biological Sciences, 364(1521), pp.1235-1243. Brosch, T., Scherer, K., Grandjean, D. and Sander, D., 2013. The impact of emotion on perception, attention, memory, and decision-making. Swiss medical weekly, 143(1920), pp.w13786-w13786.

RT @k8purcellphysio: Lovely piece by @neiljlangridge - shifting from pain to function. Very important messages for all of physio, globally.…

This week’s Clinical Insight engages with the recent piece written by @neiljlangridge in the September Frontline publication (1), published by @thecsp, outlining the challenge of #lowbackpain through the lens of celebrating World #Physiotherapy day. We explore the ways in which physiotherapy can have an impact on this challenge and suggest a change in focus can be helpful here. Impact of Physiotherapy When thinking about impact, physiotherapists can consider the resultant pain, loss of movement, or adaptation to function as the key physical areas for interest. They will also acknowledge the emotional impact of injury and life changes that low back pain can bring. Whilst doing so, it is perhaps the next step for any clinician to ensure that the wider components are considered and addressed (if possible). These include cardio-vascular health, smoking, weight, alcohol consumption, general mental and emotional well-being, general strength and health awareness. As the literature around the impact of practice upon pain is limited, and pain being a multi-factorial construct that is not necessarily modulated by singular events, then the physiotherapist needs to think wider for impact. Shifting from Pain to Function Would it be reasonable to shift the focus from pain to function? Pain over function may be an easier model for patients and clinicians to follow. Goal setting, and maintaining function whilst pain naturally (in most cases) resolves may be more fruitful, and less complicated? Secondly, the clinicians need to consider not only their impact on the functional loss of low back pain, but also on the other key areas of human wellness. By focusing on work, function, social challenges and giving advice on wellness for the future, the clinician is potentially driving a greater more improved locus of control. By focusing on the pain, and trying to impact this even as natural history occurs, does this link the patient’s belief to pain reduction to therapy, when in reality time plus context may be more powerful allies? Giving Patients Control If patients gain greater control not only over their return after injury, but also maybe over small negative health issues through the interaction, then therapy in its broadest sense creates impact. Moving forward in addressing this challenge may require a change in the narrative; replacing referrals for “pain” with functional loss and wellness improvements. Is this something to consider? 1 Frontline/Chartered Society of Physiotherapy:

We’re excited to see the positive impact this will have on both patient care and student learning! 💼💻 #Healthcare #Rehabilitation #PatientCare #TechnologyInHealthcare #HealthSciencesUniversity #RehabMyPatient @HealthSciUni